June 23rd, 2009 by KerriSparling in Better Health Network, True Stories
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I saw my niece over the weekend. She just turned seven. She had a bit of a fever and wasn’t feeling very well, so when I saw her snuggled up on the couch under a blanket, she looked every bit the little kid she is. Poor little peanut, hiding out until she felt better.
I remembered that I was about her age when I was diagnosed.
I found an old school photo from second grade, with me sitting next to my friend Bobby (who I still talk to, which is a very surreal experience, hanging out with someone I’ve known longer than I’ve known insulin injections). I was diagnosed in September, right as second grade started.
I’m in the blue dress, second row from the bottom, third from the left.
Swinging my feet. Not much for sitting still, even in second grade.
Over the last few days, I’ve been reading some emails from the CWD parents as they gear up for the Friends for Life conference in Orlando in a few weeks. These emails are sent out to a whole mailing list of attendees, and somehow I ended up on the list with all the parents. (Or maybe the list just happens to be mostly parents and I just happen to be an adult “kid” with diabetes.) These parents are comparing notes and reaching out to one another, looking forward to other parents who understand what they’re going through every day as they care for their kid with diabetes.
And I wish that my mother had this kind of support when she was dealing with my diagnosis over twenty years ago. My mom had a lackluster team of doctors at the Rhode Island Hospital (where I went for a few months before going to Joslin) and Eleanor (the only other mother of a diabetic kid that we knew of in our town and the woman who just happens to be my local Dexcom rep), leaving her with little to manage the enormous learning curve.
This weekend, I went on a bike ride with my sister-in-law, my father-in-law, and my husband. I had to remember to test beforehand, bring my meter, stash some glucose sources on several people, and monitor as re rode. A lot of thought for maybe an hour long bike ride. And it made me wonder what kind of preparation and worry my mother went through when she sent me out to play for a whole Saturday afternoon. Lot of work on my mom’s part just to keep things normal.
I forget this sometimes, how many people are really involved in keeping me healthy.
I need to call my mom.
(Granted, my diabetes diagnosis hasn’t kept me from doing much at all. And it definitely didn’t keep me from being … um, a bit of a goofball.)
*This blog post was originally published at Six Until Me.*
June 23rd, 2009 by Shadowfax in Better Health Network, Health Policy, Opinion
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What a welcome headline to see in the New York Times:
Obama Open to Reining in Medical Suits
In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.
Wow. Yay. Crisis over, let’s move on to something else now.
Or maybe not.
Senator Max Baucus of Montana, the chairman of the Senate Finance Committee, is expected to outline his proposal for a health care overhaul this week, and aides said liability protection for doctors is not part of the plan.
So, I’m guessing that Obama’s talk about supporting med mal reform runs about as deep as his comitment to gay rights. Which is to say that he’ll put out some happy talk about it to appease a necessary constituency but won’t twist any arms or spend any capital in Congress to actually make it happen.
Worse, the semi-concrete proposals I have seen don’t look like they’ll offer much protection. Jon Cohn at TNR links to a summary of a few options:
Win-Win-Win on Malpractice Reform? – The Treatment
Disclosure-and-offer programs, in which health care providers disclose unanticipated outcomes of care to patients and make prompt offers of compensation. Patients do not waive their right to sue by accepting the offer, but reportedly, few go on to file lawsuits.
It’s hard to see this as reform at all. Disclosures are nothing new any more, and it’s always been good tactics to make an offer of compensation if there actually was substandard care. I doubt this will be embraced by the medical community, since when you do a disclosure you’re basically giving a potential plaintiff a roadmap for their future lawsuit. You’re basically relying on their sense of decency to avert a suit, and how that fact can be altered I cannot imagine. Another commonly cited option would be to:
create a federal “safe harbor,” retaining the current process of adjudication but insulating physicians from liability if they adhered to evidence-based medical practices. For example, legislation introduced by Senator Ron Wyden (D-OR) in February would create a rebuttable presumption that care was not negligent if the physician followed accepted clinical practice guidelines.
Sound great, but good luck applying that standard. Consider Whitecoat’s trial, in which the case seems to be hinging on the fact that the got the right diagnosis and performed the right treatment, but he may or may not have done so in a timely fashion. Presuming there even exist “guidelines” for a particular condition or presentation, there are so many technical variables in the execution of the care under these guidelines that I don’t see how juries could be expected to put this into practice.
Consider a child with meningococcemia. It’s a no-brainer that a child with this deadly infection needs to be given antibiotics as soon as possible to have a chance to survive, and there’s probably a guideline out there that makes reference to “urgent” or “timely” administration of antibiotics. So, if a kid comes into my ER with a fever and petechiae and I don’t get the Rocephin in for, say ninety minutes, was that timely enough? Or maybe the kid didn’t have the rash on presentation, but at hour three of an extended ER work-up the rash is noted and then antibiotics are given? Or maybe I was too rushed, stupid or negligent to notice the rash and didn’t give antibiotics till hour three. My point is that it’s meaningless to say that “guidelines were followed” when it’s impossible to write guidelines that cover every clinical circumstance. Worse, if implemented narrowly, the “safe harbor” would offer very very little protection, and if construed broadly, it would make it very difficult to actually distinguish negligent care from good care.
The reason I’m spending so much time on this point is that this proposal has had explicit endorsement from Obama himself, his Chief of Staff Rahm Emanuel and his physician brother, Ezekiel Emanuel, and key legislators like Senator Ron Wyden. It sounds great, but it too is just “Happy Talk.”
The last option cited is the classic option of moving med mal cases to specialized health care courts of some variety. I’ve always thought this had great potential, but there doesn’t seem to be any political support for it and it would certainly be fought tooth and nail by the trial lawyer’s association.
So it’s looking more and more like health care reform, if enacted at all, will probably not include any meaningful or effective national solution to the ongoing malpractice crisis. Plenty of “Happy Talk,” but no action and no solutions. Not that I really expected any, coming from a Democratic President and a Democratic Congress, but hope does spring eternal.
*This blog post was originally published at Movin' Meat*
June 23rd, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Opinion
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With health care reform being the talk of the week – a top priority for President Obama and for the AMA, who wants to be sure that America’s physicians are not just talked about in the reform process but included – I can’t help but wonder if the entire system will be reevaluated or if we will end up with just another band aid.
What worries me is that it’s not just the practical end of medicine that is broken. It is not just the billing end that is unhealthy. It’s not just the reimbursement and billing end that is broken. The overall culture of how we practice medicine is broken as well as the educational system in which and through which our next generation of physicians are being trained.
In this Spring’s issue of the Tufts University Medical School Alumni Magazine, my medical school Alma Mater, resident life style issues were at the core of their headline article. Reading the article, Pressure Drop, by Susan Clinton Martin, M.D., M.P.H, ’04, a pediatrics resident, I was at times propelled back in time to my pediatrics residency at the same institution in the early 1990’s have discussions with my adviser and residency director about whether I wanted to go part time. As I was in my junior year of my pediatrics’ residency and expecting my first child, this was not an easy decision to make and I had seen mixed results with other residents who had attempted this path before me.
In the end, I opted to not go part-time and for the reasons stated in the article for most residents not opting for this path:
1. longer length of overall residency
2. decreased pay and benefits (not ideal with a baby at home!)
3. resentment of colleagues for fear of extra work on their plates
4. lack of support of the program
The honest truth is all of these issues were at play back in the 90’s with me and my colleagues and still exist today. I opted to just forge ahead and deal with having a baby and being a full time resident. I don’t regret that decision. I had the support of some attending physicians and colleagues, friends, my husband and a wonderful nanny who a PICU (Pediatric Intensive Care Unit) Attending introduced me to. It wasn’t easy but is there ever a great time to have a baby in the medical profession? Let’s be honest – residency is one of the most challenging times for a physician and adding any stress to the plate makes it worse.
Balancing work and family is never easy for any career but particularly challenging as a doctor and incredibly challenging as a resident physician where you don’t control your time. Residency programs have rather rigid schedules and even the most thought through back up systems don’t accommodate the last minute life issues that can occur unexpectedly when you are a new parent and have a new baby at home. Residencies try to be reasonable when life issues emerge but it isn’t always easy and there is always some sort of “pay back”. Even when unexpected life issues emerge – daycare crises, infant illness, or a family crisis, it’s almost easier to find a way to get to your shift. That’s how intense the pressure is on you at the time. I recall seeing an Attending pregnant with her 3rd child in tears one day because some small issue had unraveled at home. I asked a mentor about it and she told me “You’ll see when your baby comes. Some days the pressure just gets to you. Just come talk to one of us. There are a few who understand and can help.”
Reading that Dr. Martin was brave enough to go part time was like seeing a rose among weeds. The benefit to her and her family was enormous. When working her “on” months, she can focus and feel less guilty, knowing her time with her family is coming. When she has her “off” months, she’s refreshed “emotionally accessible” to her family.
A recent study by Martin’s program director Dr. Robert Vinci showed that today’s medical students value part time options in residency programs, yet few residents are utilizing those options when they do exist and the majority of programs are still very traditional. According to the article, only 25% of US residencies have part time options with only 10% of residents in those programs utilizing the part time paths.
So, there’s a big disconnect in medical education between desire for better lifestyle and what is available, no different than what those of us who have completed our education and training have experienced within the health care system for years. While it’s discouraging that our caring profession doesn’t have a system that allows us to care for ourselves and our families, it’s encouraging that we are all finally speaking up that balance between work and home isn’t a frill but a necessity – even for physicians.
This is why it is so crucial that doctors at every level of today’s health care system not only have a voice in the health care system discussions under way but be the key players in crafting the new system. This is our career, our life’s work. We would never tell the Government how to do their jobs…what makes them think they call tell us how to do ours?
*This blog post was originally published at Dr. Gwenn Is In*
June 23rd, 2009 by Jerome Ecker, M.D. in Better Health Network, Health Tips
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Cardiac rehabilitation, or guided exercise under direction of a physical therapist, is a valuable yet underutilized therapy for patients suffering a heart attack. Importantly, in those patients with ongoing risk factors related to obesity and insulin resistance/diabetes, aggressive cardiac rehab was recently shown to be especially effective.
Specifically, two groups of patients were enrolled in high intesity (5-7 days weekly of 45-60 minutes exercise) versus standard (3 days weekly of 25-40 minutes exercise).
High intensity patients lost more than twice as much weight over 5 months as standard patients (18 pounds vs. 8 pounds and had significantly greater reductions in 2 major cardiac risk factors — waist circumference and insulin resistance. At 1 year, both groups had gained a couple of pounds over 5-month weights, but total body-fat percentages in the aggressive group remained significantly lower than initial readings. Other cardiac risk factors changed too – including decreased insulin resistance, increased HDL (good) cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to HDL (good) cholesterol.
Overall then, patients who took advantage of their motivation after heart attack to aggressively address exercise goals reduced potential risk factors and set the tone for a healthier life. If you have been a heart attack sufferer, ask your doctor about cardiac rehab. If you are not a heart attack sufferer but have risks, ask your doctor about trying a program like this on your own.
Questions and comments welcome as always!
*This blog post was originally published at eDocAmerica*
June 23rd, 2009 by Dr. Val Jones in Expert Interviews
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When it comes to facilitating transportation for wounded military personnel and their families, US Airways tops the generosity list, providing about $1 million in complimentary plane tickets/year. Steve Craven, a volunteer pilot with Mercy Medical Airlift, sat next to me en route to a recent Red Cross volunteer recognition ceremony at Walter Reed Army Medical Center. He told me about the great lengths that some airlines will go to to help military families in need. For example, United Airlines and Delta Airlines have both recently offered assistance with the transportation of military personnel to cancer centers of excellence. Sadly, American Airlines, Continental Airlines, and Southwest Airlines have repeatedly turned down requests for assistance.
According to Mr. Craven, his organization coordinates about 25,000 Angel Flights, 10,000 cancer-related flights, and 6,000 Iraq war veteran flights (via Air Compassion for Veterans) per year, with over 7,000 volunteer angel pilots nationwide. Mercy Medical Airlift also runs a National Patient Travel Center which acts as a clearing house/military travel agency for charitable ticket programs, air ambulance discounts, and special lift programs – including transportation to the NIH for clinical trials.
I asked Mr. Craven what sort of patients need the air ambulance service. He responded that often times elderly veterans or military personnel with terminal illnesses wish to die at home (rather than in a specialty hospital or facility) but are too sick to travel in a regular airplane. The air ambulance service allows them to fulfill their last wish and die with dignity.
Sometimes, military families have a very sick child and have exhausted their resources but need specialty treatment at an academic center. Mercy Medical Airlift makes sure they get where they need to go. Once there, the families often stay at Ronald McDonald House or Fisher House. We’re so grateful to our partner airlines who make it possible for military families to stay together in times of medical hardship.
I offer my thanks to US Airways for their generosity to military personnel and their families – as a rehab physician, I know how much it means to them to have their family with them in sickness and in health.
Secretary Robert Gates Addresses The Red Cross At Walter Reed
